Recent insights into the mechanisms of action of two of the new anticonvulsant drugs (gabapentin and levitiracetam) have generated
developments of the next generation drugs with increased anticonvulsant potency.
The successor to gabapentin is pregabalin, which has greater affinity for the voltage-gated calcium channels than its predecessor.
There are two successors to levitiracetam — brivaracetam and seletracetam — both of which have greater affinity for SV2A than
Because of the problems of hepatotoxicity and blood dyscrasias occasionally associated with felbamate use in people, a new
derivative of the drug, fluorofelbamate, has been developed. The substitution of fluorine for hydrogen in a critical place
in the molecule is believed to prevent the formation of the toxic metabolite responsible for the reported side effects.
All of these drugs appear to have greater anticonvulsant activity in experimental rodent models than their predecessors. Pregabalin
also has shown greater anticonvulsant efficacy than gabapentin in people. Brivaracetam, seletracetam and fluorofelbamate are
in clinical trials. Pregabalin is commercially available, but the appropriate dose regimen for oral pregabalin in dogs is
still unknown. dvm